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* 1. Full Name

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* 2. Email

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* 3. Phone Number

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* 4. Company Name

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* 5. Job Title

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* 6. Current companies area of industry

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* 7. Other areas of the industry you've worked in

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* 8. Specialties/Areas of Expertise

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* 9. Which panels would be the best fit for you given your experience/expertise? (check all that apply)

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* 10. Please include 3 questions you'd like the Moderator to ask you.

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* 11. Please add the link to your LinkedIn profile

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* 12. Please upload a professional headshot that you would like to use for event promotions and mailings

PNG, JPG, JPEG file types only.
Choose File

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* 13. Please include a short bio about yourself and your career for display on the TCC Website, social media, and program for the event.

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* 14. How did you hear about us?

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